The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

Highlights of the bill include the following:

Patients go to any doctor or hospital of their choice.

The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

While federally funded, the program is to be administered by the states.

By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually - enough money to provide comprehensive, quality care to all.

Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

Comment:

By Don McCanne, MD

At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers’ H.R.676 and Rep. Jim McDermott’s H.R.1200, and now the Senate has Sen. Bernie Sanders’ S.703.

S.703 is very similar to H.R.1200, with two important additions regarding budgeting. Specified funds are budgeted for community health centers, and other specified funds are budgeted for the support of the National Health Service Corps, health professions education, and nursing education, including education of clinical nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and physician assistants.

These additions in budgeting are not simple tweaks to the bill. They provide a remedy for both the deterioration in our primary care infrastructure and the impaired access to care in underserved regions. There is an urgent need to provide the professionals and the facilities that can help fill the most serious voids in our health care delivery system today.

S.703 has been referred to the Senate Finance Committee, chaired by Sen. Max Baucus, who is determined to join with Senators Ted Kennedy, Charles Grassley and Mike Enzi to enact reform this year. Sen. Sanders will have some input as a member of the Budget Committee and a member of Sen. Kennedy’s HELP Committee.

What happens now? Will Senators Baucus and Kennedy take a fresh look at single payer as a model that addresses many of the policy problems that they currently face with their model based on private plans? Or will they accept Sen. Sanders’ contribution emphasizing the importance of health centers and primary care professionals? Or will they look at his budgeted numbers and decide that they can’t add those to the deficits they already face with their unnecessarily over-priced model of reform? Will they simply say that they’ll have to deal with that later, after they fix the insurance problem (the later that never comes)?

It’s great that there is a single payer bill in the Senate, but now is not the time to sit back and watch the process unfold. We certainly support the emphasis on improving primary care access, but we need to support that within a financing framework that will make it happen - a single payer national health program.